Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: A qualitative study

Objectives: We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members' thoughts regarding high impact solutions to expand access to essential emergency services. Design: We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting: Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results: Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care-a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions: Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These communitygenerated solutions likely have a wider applicability in the region.